This is an application for a K23 award for Dr. Nisha Bansal, a nephrologist at the University of California, San Francisco. Dr. Bansal is establishing herself as a young investigator in clinical research of cardiovascular disease and hypertension in chronic kidney disease. This K23 award will provide Dr. Bansal with the support necessary to accomplish the following goals: (1) to investigate the impact of blood pressure in patients during the transition between chronic kidney disease and end-stage renal disease;(2) to implement advanced biostatistical methods in clinical studies;(3) to work with a large multi-center cohort study;and (4) to develop an independent clinical research career. To achieve these goals, Dr. Bansal has assembled a mentoring team comprised of a primary mentor, Dr. Chi-yuan Hsu, Division Chief in Nephrology at UCSF, who conducts clinical research on the epidemiology and complications of chronic kidney disease, and three co-mentors and one scientific advisor: Dr. Alan Go, an expert on cardiovascular disease health services research and clinical epidemiology in chronic kidney disease;Dr. Elyse Foster, Director of the UCSF Adult Echocardiography Laboratory;Dr. Charles McCulloch, an authority in the use of statistical methods for longitudinal data analysis;and Dr. Raymond Townsend, who has expertise in hypertension and pulse wave analysis in chronic kidney disease. Cardiovascular disease is the leading cause of mortality in chronic kidney disease. Dr. Bansal's research will study the impact of blood pressure on cardiovascular disease and mortality during the transition between chronic kidney disease and end-stage renal disease (Aim 1);the association between central aortic pressures and outcomes during this transition period (Aim 2);the association between aldosterone, blood pressure and outcomes during the transition between chronic kidney disease and end-stage renal disease (Aim 3);and the impact of the use of anti-hypertension medications on outcomes during this transition period (Aim 4). To achieve these aims, Dr. Bansal will utilize a unique group of patients with chronic kidney disease assembled as part of the NIDDK-funded Chronic Renal Insufficiency Cohort (CRIC), a national study composed of 7 clinical centers. She will utilize advanced multivariate statistical analyses to accomplish these aims. This research will form the basis for a cohort study to investigate the impact of blood pressure in patients with heart failure and advanced chronic kidney disease, to be proposed in an R01 grant application before the end of the K award. PUBLIC HEALTH RELEVANCE: Improved understanding of the impact of blood pressure, measurement of blood pressure, and determinants of blood pressure in patients with advanced stages of kidney disease is critical to improve long-term cardiovascular complications and survival in this high-risk group of patients.